Read Microsoft Word - All - Sample Application - US.doc text version

APPLICATION FOR EMPLOYMENT

We at Plato's Closet are committed to a policy of equal treatment and opportunity in every aspect of our employment relations without regard to race, color, religion, sex, national origin, age, disability, or any other legally protected class status. This includes, but is not limited to, recruiting, hiring selection for training, transfers, promotion, compensation, and any company sponsored social and recreational programs.

PLEASE PRINT

Name _______________________________________________________________________ Date ________________________________________ Present Address ___________________________________________________________________________________________________________

Street City State Zip

Social Security #_______________________________________________________________ Telephone (___)______________________________ Referred by Advertisement Agency Person Yes No Other _________________________________________________ State age if under 18 ___________________________________

Are you legally eligible for employment in the U.S.A.?

Position applying for _______________________________________________________________ Salary expected _________________________ Are you available to work Full-time Part-Time Specify schedule limitations ___________________________________________

Date available for work _______________________________ List friends or relatives in our employ _____________________________________ Were you previously employed by us? Yes No If yes, when _______________________________________________________

Other name(s) used while attending schools or places of employment indicated on this form ______________________________________________

Can you perform the functions of this job with or without reasonable accommodations? Yes No If No, please explain: ___________________________________________________________________________________ _________________________________________________________________________________________________________________________ Yes No If yes, please explain: (Note - A conviction alone will not automatically bar you from Have you ever been convicted of a felony? employment.) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Military Service? Yes No Branch of service and rank _______________________Dates of Service______________________________ Special Training ___________________________________________________________________________________________________________

EDUCATION

Name and Location Course of Study Scholastic Average Dates of Attendance Yes/No High School/GED College Vocational Other Graduated Mo/Year Degree

N/A

N/A

Additional comments regarding education ________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________

SKILLS

List Computer Software Packages in which you are proficient _____________ ______________________________________________________________ Cash Register ___________________________ 10-Key _________________ Other Skills _____________________________________________________ What languages do you: speak fluently ______________________________ write fluently _______________________________ read fluently _______________________________

EMPLOYMENT HISTORY

(List present or most recent employer first) Name of Company __________________________________ Address ________________________________________________________________ Supervisor _________________________________________ Salary _______________ Phone ____________________________________________ Job Title ________________________________________________________ Date Started __________________ Date Left ___________________ Job Description ___________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Reason for Leaving: Name of Company __________________________________ Address ________________________________________________________________ Supervisor _________________________________________ Salary _______________ Phone ____________________________________________ Job Title _________________________________________________________Date Started __________________ Date Left ___________________ Job Description ___________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Reason for Leaving: Name of Company __________________________________ Address ________________________________________________________________ Supervisor _________________________________________ Salary _______________ Phone ____________________________________________ Job Title _________________________________________________________Date Started __________________ Date Left ___________________ Job Description ____________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Reason for Leaving: Name of Company __________________________________ Address ________________________________________________________________ Supervisor _________________________________________ Salary _______________ Phone ____________________________________________ Job Title _________________________________________________________Date Started __________________ Date Left ___________________ Job Description ____________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Reason for Leaving:

AUTHORIZATION FOR BACKGROUND CHECK: I authorize Plato's Closet to verify employment, except as noted below, as well as conduct criminal and vehicular record check.

Indicate those you do not wish contacted:________________________________________________________________________________________ Signed: ______________________________________________________________________________Date: _______________________________

REFERENCES

Please list three persons other than relatives or personal friends, who can judge your work ability.

1) Name _________________________________________________________ Occupation ______________________________________________ Address ______________________________________________________________________ Phone ____________________________________ 2) Name _________________________________________________________ Occupation ______________________________________________ Address ______________________________________________________________________ Phone ____________________________________ 3) Name _________________________________________________________ Occupation ______________________________________________ Address ______________________________________________________________________ Phone ____________________________________

Please use the space provided below to summarize any additional information necessary to fully describe your qualifications. _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________

PLEASE READ

All information written on this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation of facts in this application disqualifies me from further consideration - or if employed - is grounds for dismissal. I understand that any employment offer is contingent upon satisfactory references and I authorize Plato's Closet to investigate past employment and education history, as well as references given on application. I understand that if employed such employment may be terminated for just cause, or no cause, by Plato's Closet or myself at any time. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its Owner, and then only when in writing and signed by the Owner, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. I fully understand and agree to all statements above. _______________________________________________________ Signature _________________________________________________ Date

OFFICE USE ONLY

Interviewed by _____________________________________________________________________ Date __________________________________

Referral Source _______________________________________________________________ Hired _________________ Not Hired _____________ Starting Date ___________________________ Position ________________________________________________ Salary _____________________ Location ______________________________________ Reporting To ___________________________

Information

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